whoRyou Posted March 27, 2014 Share Posted March 27, 2014 diagnostic peritoneal lavage (there's one for the students to look up!) I looked up peritoneal lavage and I quote from General Practice Notebook, Diagnostic peritoneal lavage was introduced as a more accurate means than needle aspiration of assessing visceral injury following blunt abdominal trauma. Diagnostic peritoneal lavage may be considered when there is: an alteration in the level of responsiveness of the patient to abdominal examination resulting from head injury, alcohol, drugs or spinal cord damage. absence of specific abdominal signs when it is impossible to continue to monitor potential changes in abdominal findings due to the patient undergoing other required procedures, e.g. neurosurgical operation or maintenance on a respirator It is said to be up to 98% reliable in determining the presence of absence of intra-abdominal injury following blunt trauma. However, poor predictive value is found for injuries to the retroperitoneal portion of the duodenum and colon, pancreas, and extraperitoneal part of the urinary bladder. Laparoscopic diagnosis is an increasingly favoured option. Quote Link to comment Share on other sites More sharing options...
dmdpac Posted March 27, 2014 Share Posted March 27, 2014 I thought it was mediastinal air along the right heart border edge as seen on CT, i.e.-mediastinal ptx. I, too, thought I saw mediastinal air on the CT image. I also missed the sulcus sign. Even knowing it's been identified on the CXR doesn't help. Good case, though. Thanks for sharing. Quote Link to comment Share on other sites More sharing options...
Febrifuge Posted March 27, 2014 Share Posted March 27, 2014 I saw it, but it's really subtle and doesn't persuade me, just looking at it in isolation. I doubt I would have gotten a supine CXR in the first place -- but that's gut instinct. I wonder about the sensitivity and specificity of deep sulcus sign on supine CXR, vs. looking for apical air on a standing CXR. Then again, I just said those are terrible... Long story short, like EMED says, clinical diagnosis and you confirm it with a CT. Quote Link to comment Share on other sites More sharing options...
PAruby Posted April 19, 2014 Share Posted April 19, 2014 New grad heading into EM as soon as hospital credoentialling is done (maybe July/August ish)... Thanks for sharing these, and also being honest when you experts miss something. Makes me feel a little better that even after many years of practice we are all still learning - another reason I love medicine :) Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2014 Author Moderator Share Posted April 30, 2014 80 yr old lady, lives alone. trip/fall landing on wrist. ortho said "splint and send to fracture clinic in 1 week". your thoughts? (sorry, didn't copy the lateral- it's as ugly as you think with significant displacement, etc). Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 30, 2014 Moderator Share Posted April 30, 2014 80 yr old lady, lives alone. trip/fall landing on wrist. ortho said "splint and send to fracture clinic in 1 week". your thoughts? (sorry, didn't copy the lateral- it's as ugly as you think with significant displacement, etc). this meets so many criteria for operative treatment, I literally do not have the time or energy to list them all. TFCC tear, ulnar styloid displacement, definitely unstable druj, the list goes on. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2014 Author Moderator Share Posted April 30, 2014 this meets so many criteria for operative treatment, I literally do not have the time or energy to list them all. yup, I made a big stink and got pt transferred to the ortho service. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2014 Author Moderator Share Posted April 30, 2014 yup, I made a big stink and got pt transferred to the ortho service. they should have been all over this as a great case for their residents but the guy totally tried to blow me off, even after seeing the film. unbelievable. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 30, 2014 Moderator Share Posted April 30, 2014 they should have been all over this as a great case for their residents but the guy totally tried to blow me off, even after seeing the film. unbelievable. I cannot imagine anyone saying wait a week on this. Good for you for pushing. Waiting on this probably saved her from life long pain, or worse. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2014 Author Moderator Share Posted April 30, 2014 he said something about her age and it not being a big deal to which I said this lady was totally with it, otherwise healthy on no meds and lived alone, with a significant injury to her dominant arm. he basically took it after I guilted him into it. his resident did the case. it's not like he even needed to get out of bed as it was the middle of the afternoon.... Quote Link to comment Share on other sites More sharing options...
Febrifuge Posted May 1, 2014 Share Posted May 1, 2014 You saved that ortho a really entertaining M&M conference. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 9, 2014 Author Moderator Share Posted May 9, 2014 Should be an easy one. Haitian Child with weakness who "can't climb the mountain" Quote Link to comment Share on other sites More sharing options...
fakingpatience Posted May 9, 2014 Share Posted May 9, 2014 Should be an easy one. Haitian Child with weakness who "can't climb the mountain" Anemia? Nail beds look really pale, and based on presentation and frequency of anemia in Haiti Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 9, 2014 Author Moderator Share Posted May 9, 2014 Anemia? Nail beds look really pale, and based on presentation and frequency of anemia in Haiti yup. hgb = 3.6 Quote Link to comment Share on other sites More sharing options...
Woody85 Posted May 14, 2014 Share Posted May 14, 2014 yup. hgb = 3.6Hemolytic right...considering the jaundice?*Disclaimer - pretty badly color blind:) Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 14, 2014 Author Moderator Share Posted May 14, 2014 Hemolytic right...considering the jaundice? *Disclaimer - pretty badly color blind:) nope, iron deficiency. mcv around 50. Quote Link to comment Share on other sites More sharing options...
Woody85 Posted May 14, 2014 Share Posted May 14, 2014 nope, iron deficiency. mcv around 50.Huh, good to know. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 14, 2014 Share Posted May 14, 2014 Follow up student question to above, what type of MCV result would one expect to see with a hemolytic process? Quote Link to comment Share on other sites More sharing options...
Woody85 Posted May 14, 2014 Share Posted May 14, 2014 Greater than 100 indicating large RBC... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 9, 2014 Author Moderator Share Posted July 9, 2014 new one on me: female psych pt brought in by caregiver with complaint of possible vag fb inserted by pt: lateral view confirmed position. removed by gyn using procedural sedation. ( I didn't want to lacerate anything. ends of the spring were sharp). Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 9, 2014 Moderator Share Posted July 9, 2014 new one on me: female psych pt brought in by caregiver with complaint of possible vag fb inserted by pt: lateral view confirmed position. removed by gyn using procedural sedation. ( I didn't want to lacerate anything. ends of the spring were sharp). I would've made so many tigger jokes... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 9, 2014 Author Moderator Share Posted July 9, 2014 I would've made so many tigger jokes... most of the jokes were "jack in the box" related... Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 9, 2014 Moderator Share Posted July 9, 2014 most of the jokes were "jack in the box" related...OOOOOHHH! So much better. Quote Link to comment Share on other sites More sharing options...
cbrsmurf Posted July 9, 2014 Share Posted July 9, 2014 new one on me: female psych pt brought in by caregiver with complaint of possible vag fb inserted by pt: lateral view confirmed position. removed by gyn using procedural sedation. ( I didn't want to lacerate anything. ends of the spring were sharp). Did you tell her: No need to get your panties all twisted? I'm here all week, folks. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 9, 2014 Moderator Share Posted July 9, 2014 most of the jokes were "jack in the box" related... Did you say see you next spring? 1 Quote Link to comment Share on other sites More sharing options...
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